“The walk is a way to be supportive and acknowledge what has happened. It’s an activity where you’re just out being supportive and enjoying the company of everyone who cares about you,” he said. “To be able to do something without having to talk about it is good. Just being able to be there is good.”

Diagnosed with acute promyelocytic leukemia in February 2010, Alex Menze expected the fight of his life, but the struggles that followed his treatment came completely unforeseen.

Menze, then a recently married 29-year-old finishing up his medical residency at the University of Virginia and planning for a stint in the Air Force, girded himself for the coming battle.

Cancer was the enemy, something to be beaten.

His friends, family and colleagues rallied behind him as he underwent treatment and took regular doses of all-trans retinoic acid, a drug that has increased a patient’s odds of beating APL from 35 percent to 45 percent to between 90 percent and 95 percent. After four rounds of chemotherapy, Menze got the great news: Leukemia cells no longer appeared in his blood tests.

On the mend, Menze was stationed at Andrews Air Force Base, leaving behind his support group of friends and family and facing a second fight — a struggle to return to normalcy.

“That’s when the truth of cancer came to me,” the Old Town resident said. “When you’re fighting it, it’s easy because you’ve got an enemy to fight. But then you’re left with a deep-seated, rotting fear.”

Menze, who didn’t recover from the treatment as quickly as he had hoped, worried he would never be fully functional again. After the chemotherapy, there were concerns of infertility. He no longer planned ahead in years and decades, but kept it to months for fear of remission.

Any sense of youthful invulnerability had evaporated.

“It’s a difficult thing to describe,” Menze said. “Going through treatment and dealing with a life-or-death situation sets your mind up to deal with the one big problem in your life. Turning that around is nearly impossible.”

His wife, Christina, recognized the change as well. Before the diagnosis, they had an entire lifetime mapped out before them: finish school, move to Washington, raise a family and so on.

“I think that before he was diagnosed we were planners,” she said. “Everything is so planned out, and when a diagnosis like that comes along, it really humbles you a lot.”

Just booking an airline flight two months out was a big step, Menze said.

Beyond cancer

Menze isn’t alone. Many cancer survivors struggle to return to the life they had before, said Dr. Aziza Shad, chief of pediatric hematology/oncology and blood and marrow transplantation at Georgetown University Hospital.

There are the scars, mental and physical, from treatment, she said. Relationships are strained and some survivors develop a sort of nihilism, latching on to risky behavior.

Cancer patients need psychosocial and emotional treatment from the get-go. Therapy, support groups and counseling coupled with yoga, exercise and a whole host of options need to be available for survivors.

Cancer is a life-changing event, said Joan Giblin, a nurse practitioner heading up the Winship Cancer Institute’s new survivorship program.

“We do so much to assault the body … we change so much. Their whole being is changed with cancer,” she said. “You can’t just bounce back into the life you’ve had before, you have to ease back. Nobody warns you, and it’s a big hit in the head when they can’t [bounce back].”

Some cancer survivors display psychosocial symptoms akin to post-traumatic stress disorder. The medical community is getting better at helping survivors readjust to life beyond cancer, she said.

“We have to address these patients,” she said. “We’ve changed their lives, and we need to be there for them.”

Done talking

Menze continues to receive ATRA treatment, and he has several years to go before doctors will consider him cured. He has spoken with other survivors who were stricken with cancer in early adulthood, and it’s helped give him hope for the future.

While he hasn’t thrown himself into cancer awareness and fundraising as he’d planned when first diagnosed with APL, Menze has participated in the Leukemia and Lymphoma Society’s Light the Night walk among a few other programs. The organization named him an “honored hero” in this year’s walk.

For Menze, it’s a welcome opportunity to support cancer survivors and acknowledge the disease — without talking about it. In the months following his diagnosis, he’s done enough talking about disease.